CS000000-A | 11/10/21

COVID-19 State of Vaccine 

Confidence Insights Report

Report 18 | November 10, 2021 | Date Range: October 12 – 25, 2021

Summary

Findings. The first major theme we identified was that consumers continue to express frustration with vaccine requirements 

and international travel guidance. The second major theme was that news reports and misinformation about current and former 

high-profile government officials increased online conversations about consumer misgivings about COVID-19 vaccines. An 

emerging theme during this reporting period was that consumers are interested in learning which booster dose and primary 

series combinations are most effective and safest. A continuing and evolving theme was that COVID-19 vaccination in children 

ages 5-11 years old continues to be a topic of conversation amongst parents and public health professionals. Finally, claims 

of infection-induced immunity, also referred to as natural immunity, as equal to or greater than approved COVID-19 vaccines 

persist and have informed legal and legislative action.

Ways to take action. Federal, state, and local partners should continue to work together to explain the rationale for updated 

guidance, respond to gaps in information, and confront misinformation with evidence-based messaging. The goal of these 

efforts is to increase confidence in COVID-19 vaccines and expand vaccine uptake more broadly. To demonstrate that 

vaccination is a norm among first responders, share messages about the percentage of first responders that already received the 

vaccine, along with personal stories regarding why they got vaccinated and, if they had hesitancy to get a vaccine, what helped 

them overcome their hesitancy. Create and disseminate messages about the frequency of severe COVID-19 outcomes in people 

who were previously vaccinated compared to those who are not vaccinated. Finally, share messages about the safety and 

effectiveness of mixing brands of the COVID-19 primary series and booster doses.and languages people understand. 

Contents

2 Aims and Methods

3 Major Themes

3 Consumers continue to have questions and express frustration 

with vaccine requirements and international travel guidance.

4 Consumer distrust about COVID-19 vaccines may have 

increased because of news reports and misinformation about 

current and former high-profile government officials.

5 Emerging Themes

6 Continuing and Evolving Themes

7 Appendix: Inputs and Sources

Centers for Disease Control & Prevention, 

COVID-19 Response, Vaccine Task Force

Vaccine Confidence & Demand Team, Insights Unit

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).
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COVID-19 State of Vaccine Confidence Insights Report | Report 18 | November 10, 2021

Aims and Methods

By rapidly reviewing and analyzing numerous sources and inputs (see Appendix), the biweekly COVID-19 State of Vaccine 

Confidence Insights Report emphasizes major themes influencing COVID-19 vaccine hesitancy and uptake. These are 

characterized by the level and type of threat to vaccine confidence, degree of spread, and directionality. In addition, by 

examining how consumers think and feel, social processes, and the practical issues around vaccination, the Insights Report 

seeks to identify emerging issues of misinformation, disinformation, and places where intervention efforts can improve vaccine 

confidence across the United States.

The information in this report is only a snapshot, and certain populations may be underrepresented. Images and quotes are 

illustrative examples and are not meant to comprehensively cover all content related to the highlighted themes. 

Theme Classification

How do you classify this theme/information? 

High risk Moderate risk Low risk Positive sentiment

 May lead to vaccine 

refusals and decreased 

uptake 

 Wide reach, pervasive  

 Potential to trigger 

hesitancy to vaccination

 Moderate reach, modest 

dissemination 

 Concerning, but low risk 

to vaccine confidence 

 Limited reach, limited 

dissemination 

 Could increase vaccine 

confidence, intent, or 

motivation

 Variable reach and 

dissemination

How has this theme/idea changed over time (since last report or over the course of multiple reports)? 

Increasing

Information spreading rapidly 

Stable

Information remaining 

constant at prior level 

Decreasing

Information is not gaining further 

traction and there has been no 

indication of additional activity 
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COVID-19 State of Vaccine Confidence Insights Report | Report 18 | November 10, 2021

Major Themes

Consumers continue to have questions and express frustration with vaccine 

requirements and international travel guidance. 

Social media users and other consumers continue to speak out against vaccine requirements.a,1,2,3,4 However, the conversation 

appears to have shifted during the last two weeks, focusing more on terminations, fines, and vaccine requirement protests, and 

less on consumers’ general disapproval of the requirements. During this reporting period, consumers increasingly searched 

Google with keywords related to terminations for not receiving the COVID-19 vaccine. One particular search phrase (health care 

workers speak out on why they would rather lose their jobs than take a COVID-19 vaccine) comes from a news article discussing 

the reasons healthcare workers give on why they would rather lose their job than take a COVID-19 vaccine.b,5A recent poll shows 

a split among US adults on the appropriateness of vaccine requirements for healthcare workers.6Opposition to the vaccine 

and/or vaccine requirements among healthcare workers, police officers, and other employees, including NBA players continue 

to threaten vaccine confidence, with social media users using such opposition to support their personal decisions not to get 

vaccinated.7,8,9,10,11

News articles discussing the number of 

employees leaving their jobs rather than 

receiving the COVID-19 vaccine continue to 

drive the misperception that this practice 

is common.12,13,14,15 Online discussions 

and online searches relating to groups and individuals protesting the vaccine requirements increased as professional 

athletesb,16,17,18,19,20 and employees21,22,23 call attention to their cause. During this reporting period, online searches related to 

New York City vaccine requirements and protests continued to rise.b Legal challenges related to vaccine requirements also 

continued during this reporting period24,25,26 with some social media users seeing the challenges as validation of their vaccine 

hesitancy.27,28,29 Some social media users continue to believe that CDC employees and other federal government workers are not 

required to get vaccinated, despite having a federal employee vaccination requirement, and believe this is hypocritical.30,31,32

After the October 25 travel announcement that as of November 8, 2021, international travelers to and from the United States 

would need proof of COVID-19 vaccination status or a recent test,33,34 many people had questions about the rules. For example, 

consumers questioned if vaccination with any vaccine would qualify, if travelers needed boosters or just the primary series, if 

children need to be vaccinated, travelers from which countries are affected, post-travel quarantine requirements, and if paper 

vaccination cards will be required.c,35,36,37,38,39,40 Google searches related to the phrase “travel ban” also increased during this 

reporting period.d Some social media users and news outlets are reporting travelers’ interest in using fake vaccine cards.41,42

Other information gaps related to vaccine requirements persisted into this reporting period. Specifically, individuals wanted 

to know what to do if they lost their vaccination cards.c,d,43 Consumers had questions about obtaining a religious exemption 

and if the exemption would apply in all circumstances when proof of vaccination is required (i.e., work requirement, travel 

requirement, participation in school activities, attending public events).c,44,45,46 Misinformation circulated that the federal vaccine 

requirement was invalid because it was announced during a press conference rather than a written executive order.47,48,49

Another circulating piece of misinformation is that vaccine requirements for COVID-19 are comparable to HIV workplace 

requirements, yet there are NO workplace requirements for people living with HIV, making COVID-19 vaccination requirements 

hypocritical.50,51,52,53,54,55

Ways to act: 

 Create and disseminate personalized messages from healthcare workers, police officers, and firefighters on why they got 

vaccinated and, if they had hesitancy to get a vaccine, what helped them overcome their hesitancy. 

 Demonstrate that vaccination is a norm among first responders by creating and disseminating messages about the 

percentage of first responders that already received the vaccine. 

 Partner with trusted messengers to counter the misinformation that there is no federal vaccine requirement.

a

CDC-INFO

b

Google Trends

c

CDC-INFO

d

Google Trends
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COVID-19 State of Vaccine Confidence Insights Report | Report 18 | November 10, 2021

Consumer distrust about COVID-19 vaccines may have increased because 

of news reports and misinformation about current and former high-profile 

government officials. 

Initial reports of Colin Powell’s death on October 18, 2021 announced 

that the 84-year-old retired general had died from complications 

related to COVID-19 despite being fully vaccinated.56,57,58,59,60,61

Vaccine advocates and skeptics discussed this on social media 

and in online comments, where skeptics offered divergent 

arguments.62,63,64,65,66,67,68,69,70 Most skeptics ignored Powell’s 

underlying immunocompromising conditions, asserting that his 

fatal breakthrough infection proved vaccination is ineffective, 

actively dangerous, or both, while a smaller number saw evidence 

of a conspiracy to inflate the pandemic death toll, arguing that 

an “84-year-old dying from ‘complications of Covid’ despite being 

fully vaccinated and having blood cancer doesn’t necessarily 

mean vaccines don’t work. It means our Covid death reporting is 

fraudulent.”71,72,73 Interest in Powell’s cancer and his vaccination status 

was reflected in Google search data, with a spike in searches on his 

name, “covid shot,” “vaccinated,” “cancer,” and “multiple myeloma” 

from October 18–20, 2021. Searches related to the string “what covid vaccine did Colin Powell have” further suggest that some 

consumers considering a booster dose might want to avoid the vaccine that Powell received.e

Commenting on-air about Powell’s death, a former CDC Director said “more than 40% of people who died in Maryland were fully 

vaccinated.”74 This piece of misinformation75 was repeated by vocal vaccine deniers and amplified across the misinformation 

ecosystem under the headline “Former CDC Director gives alarming statistic on fully vaccinated COVID deaths.”76,77,78,79,80,81 

Blogs and websites sharing the quote cited the statistic, which most labeled “alarming.”82,83,84 The statement was widely shared 

online and amplified misinformation channels. On October 19, 2021, a television station reported, “According to the Maryland 

Department of Health, 30% of those who have died from COVID-related illnesses, between September 1 and October 15, were 

fully vaccinated.”85,86,87 Three days later, the station presented a follow-up report under the headline “Doctors dispel deceiving 

statistics on COVID-19 deaths in Maryland.”88 These reports appear to be the only mainstream response to the statistic cited on 

October 18, which seems not to have been evaluated by any fact-checking service.

On October 20, 2021, reports that the National Institutes of Health (NIH) had unintentionally provided indirect funding for 

so-called gain-of-function research on naturally occurring bat coronaviruses at the Wuhan Institute of Virology (WIV) stirred 

outrage among vaccine critics, who called for the firing or prosecution of responsible parties, including the White House Chief 

Medical Advisor, who had categorically denied that NIH funding supported such research in testimony to Congress.89,90,91,92 Then, 

on October 24, 2021, allegations that “his National Institutes of Health division provided a grant to a lab in Tunisia to torture 

and kill dozens of beagle puppies for twisted scientific experiments” appeared in certain US and UK newspapers and amplified 

online.93,94,95,96,97 The stories had a large enough impact that variations on the advisor’s name and “puppies,” “dogs,” “beagles,” and 

“lied” were rising search terms at the end of the reporting period.f

Ways to act: 

 Create and disseminate messages about the frequency of severe COVID-19 outcomes in people who were previously 

vaccinated compared to those that are not vaccinated including messaging about findings from a recent MMWR that 

reported immunity from vaccines was more protective than immunity from recent SARS-CoV-2 infection. 

 Partner with trusted messengers, especially medical and scientific professional associations, about the utility, rules, and ethical 

considerations of using animals in clinical trials. 

e

Google Trends

f

Google Trends
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COVID-19 State of Vaccine Confidence Insights Report | Report 18 | November 10, 2021

Emerging Themes

Consumers are interested in learning more about booster doses, especially which 

booster dose and primary series combination are most effective and safest. 

On October 21, 2021, the CDC recommended that for groups 

recommended to receive a booster, people have the option to receive 

any of the FDA-approved or FDA-authorized COVID-19 booster 

products (Pfizer-BioNTech, Moderna [50 μg in a volume of 0.25ml], or 

Janssen).98,99,100 This authorization refocused online conversations toward 

understanding the updated guidance. Consumers increasingly searched 

on Google for more information about mixing brands of the primary 

series with the booster dose.g,h Some social media users expressed 

concern about the safety of receiving a different brand of a booster dose 

than the primary series.101,102,103 Consumers were interested in which 

combination of primary series vaccine and booster dose was the most 

effective at preventing or decreasing the severity of symptoms of COVID19.h,104,105,106 Consumers are especially interested in mixing their primary 

series vaccine with a Moderna booster dose.h,107,108,109,110,111,112,113,114

Consumers and some social media users continue to 

have questions about the duration of booster dose 

effectiveness, the justification of additional doses if the 

primary series “didn’t work” and eligibility questions. 

For example, are booster doses required, who is eligible to receive booster doses, what pre-existing conditions qualify 

a person to receive a booster dose, and how long should one wait to get a booster after being infected with COVID19.g,h,i,115,116,117,118,119,120,121 Consumers continued to express interest in getting a Moderna booster dose and expressed a desire for 

CDC to authorize a Moderna booster.h,122,123,124,125,126

Ways to act: 

 Create and disseminate messages about the safety and effectiveness of mixing brands of the COVID-19 primary series and 

booster doses.

 Continue to partner with trusted messengers to share messages about the eligibility and effectiveness of the COVID-19 vaccines 

and booster doses.

 Clarify that persons who received Pfizer-BioNTech, Moderna, and Janssen vaccines can receive boosters and reference CDC’s 

website.

g

CDC-INFO

h

Google Trends

i

SEMrush
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COVID-19 State of Vaccine Confidence Insights Report | Report 18 | November 10, 2021

Continuing and Evolving Themes 

The themes below have been noted in previous reports and continue to undermine vaccine confidence. The information 

highlighted below focuses on what is new or different from previous reports. For additional context and previous 

recommendations on these themes, see previous Insights Reports.

COVID-19 vaccination in children ages 5-11 years continues to be a topic of conversation 

among parents and public health professionals. 

Parents and public health professionals continued to discuss the anticipated emergency use authorization of COVID-19 vaccines 

in children ages 5-11 years. Due to the recent FDA authorization and ACIP recommendation, we anticipate this will continue to 

be a topic of high interest. Many consumers question the necessity and safety for childhood COVID-19 vaccination, asserting 

that low case numbers and deaths,127,128,129,130 coupled with harmful side effects and adverse events,131,132,133,134 contradict the 

urgency for vaccinating children against COVID-19.135,136,137

An analysis of search terms showed an increased interest in both the safety and risks of COVID-19 childhood vaccination. Google 

trends indicated “covid vaccine for children under 12” was a frequently recorded search term, demonstrating consumers’ 

continued concern and attention to this topic.j

 Before the October 29, 2021 FDA Emergency Use Authorization for the PfizerBioNTech vaccine in children ages 5-11 years and the corresponding November 2 ACIP recommendation,138  many parents 

reported looking forward to the prospect of vaccinating children, while others remain adamantly opposed.139,140,141,142

Despite growing interest in childhood COVID-19 vaccination, a recent poll found that 30% of parents say they will “definitely 

not” get their children ages 5–11 years vaccinated, while 27% of respondents stated they will get their children ages 5–11 

years vaccinated “right away.” The same poll showed parents are hesitant to vaccinate their children due to fear of long-term 

effects, serious side effects, and impacts on fertility. Additionally, parents are concerned about taking time off to take their child 

to get vaccinated, traveling to the site, and potential cost.143

Claims that infection-induced immunity is equal to or greater than approved COVID-19 

vaccines persist and informed legislative action. 

Notable breakthrough infections,144,145,146 coupled with legal147,148,149,150 and legislative151,152 responses to vaccine requirements, 

have sustained consumer interest in comparing the protective effect of vaccine-induced immunity to infection-induced 

(or natural) immunity. The protection from infection-induced immunity varies from person to person153 and choosing 

not to vaccinate increases the risk of reinfection, hospitalization, or death.154,155,156 Still, vaccine hesitant consumers cite 

research157,158 claiming infection-induced immunity provides a protective effect “as good as”159 or “more robust than”160 vaccines.  

Some consumers noted the emphasis of vaccine-induced over infection-induced immunity might be indicative 

of politicization161,162,163 – an explicit demotivator for the vaccine hesitant164,165 – and a failure to “follow the science.”166 Some 

consumers maintain their hesitancy stems from an opposition to perceived governmental overreach and not COVID-19 vaccines 

or science at large167,168.  However, people who are unvaccinated rank vaccine safety concerns and side effects as primary 

reasons for not vaccinating when polled.169 As vaccine requirement deadlines approach, consumers may seek exemptions due 

to infection-induced immunity. Local governing bodies have drafted more than 100 pieces of legislation potentially limiting 

public health efforts to increase vaccination rates or implement community mitigation strategies,170 including some allowances 

for exemptions based on antibody presence and explicit mentions of natural immunity.171,172,173 These legislative efforts indicate 

a misalignment of consumer-level understanding of antibody presence and the amount of protection against reinfection they 

provide.174,175,176

New ways to act: 

 Create and share messaging about a recent MMWR that reported the protection of vaccination is much stronger than recent 

infection with SARS-CoV-2. Work with trusted messengers to share the information from this report.

j

Google Trends
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COVID-19 State of Vaccine Confidence Insights Report | Report 18 | November 10, 2021

Appendix: Inputs and Sources

Type Input Cadence Sources Tactics for Utilization

Social Media 

Listening 

& Media 

Monitoring

Communication Surveillance 

Report

Daily on 

weekdays

Google news

 Meltwater

CrowdTangle

Native platform searches

 Share of voice topic analysis to identify themes

 Emerging topics 

Meltwater Daily  Facebook, Twitter, Instagram

 Blogs

News media

Online forums

 Share of voice topic analysis

 Emerging theme topics

Identify high reach/velocity topics

OADC (Office of the 

Associate Director of 

Communication) Channel 

COVID-19 Post metrics

Weekly  Sprout Social

Native OADC account analytics

 Analyze # of posts, topics 

 Success of messages, # of impressions, reach, # 

engagements

OADC Channel Comment 

Analysis

Daily on 

weekdays

Native platform searches  Sentiment analysis

Identify message gaps/voids

Direct 

Reports

CDC-INFO Metrics Weekly CDC-INFO inquiry line list

 Prepared response (PR) usage report

 Cross-compare PR usage with inquiry theme 

analysis

 Sentiment analysis

Identify information gaps/voids

VTF Media Requests Weekly  Media request line list  Leading indicator for news coverage

Identify information gaps/voids

Web Metrics Weekly  Top pages

Google search queries

 Top FAQs

 Referring domains

Identify information gaps/voids,

Identify keywords/search terms, changes in web 

traffic

Research

Poll Review Weekly Harris Poll, PEW research, Gallup Poll, 

KFF 

New data related to vaccine 

hesitancy

Identify socio-behavior indicators related to 

motivation and intention to vaccinate 

Literature Review Weekly  PubMed, LitCovid, ProQuest Central 

New data related to vaccine 

hesitancy

Identify current vaccination intention

Identify barriers to vaccination

Third Party 

Reports

Tanaq Social Listening 

+Media Monitoring Report

Weekly  Meltwater

 Sprout Social

 First Draft

Native platform searches

 Trending topics

Demographic and geographic conversation 

monitoring

CrowdTangle content 

insights report

Biweekly  Facebook  Top pages (voices), groups

General trends/sentiment analysis

News analysis through posts

First Draft News Vaccine 

Misinformation Insights 

Report

Monthly  Proprietary methods  Media trends analysis

 Emerging threats and data deficits

Online vaccine narratives

Project VCTR Weekly  Proprietary methods National and regional trends in negative 

attitudes toward vaccination

Conversations around Legislation

Virality Project Weekly  Proprietary methods  Mis- and disinformation trends related to 

COVID-19 vaccine